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Buprenorphine is a medication used for the treatment of opioid addiction and dependence in a practice known as buprenorphine maintenance treatment or, more broadly, medication-assisted treatment (MAT).
A buprenorphine treatment program that includes both medication and counseling is more effective than buprenorphine or therapy alone, and this is typically how MAT is provided.
What Is Buprenorphine?
Buprenorphine is a medication approved by the U.S. Food and Drug Administration (FDA) for the treatment of opioid addiction, also known as an opioid use disorder.
In addition to opioid treatment programs, it is available with a doctor’s prescription, which has greatly increased treatment access. The medication reduces physical cravings for opioids and reduces withdrawal symptoms, ultimately lowering your risk for relapse.
Buprenorphine maintenance treatment is typically combined with therapy to provide patients with a comprehensive recovery plan that focuses on healing the whole person; this is known as medication-assisted treatment.
While buprenorphine treatment can reduce cravings and opioid withdrawal symptoms, counseling helps address the underlying issues that influenced opioid misuse in the first place and teaches recovering individuals effective coping strategies.
In essence, the buprenorphine helps you stay sober today while you’re in counseling to build the skills and the changes that will help you stay sober long-term.
Formulations
Buprenorphine has different formulations and methods of administration. It exists in tablets or small, thin films, both of which you place under the tongue (sublingual) or inside of your cheek (buccal) until they dissolve. You would take them once every 1-2 days. You never chew the tablets or swallow them whole.
If you have already been treated with the oral formulations of buprenorphine and are medically stable on them, it is possible to get buprenorphine implants. With these, you don’t have to worry about losing tablets or films, forgetting to take them, or misusing them.
The implants are four one-inch-long rods that are surgically placed under the skin on the inside of the upper arm, and they release buprenorphine into your body on a consistent basis. These implants provide treatment for six months, then have to be surgically removed.
New implants are inserted in the opposite arm for one additional course of treatment if needed. An implant can come out or protrude from the skin. Therefore, you should visit your provider during the first week after getting the implants and at least once per month for counseling.
Buprenorphine is often combined with naloxone (commonly known by the brand name Narcan), an opioid antagonist that is used to reverse the effects of an opioid overdose. Adding naloxone decreases the likelihood of misuse of the medication. If someone injects buprenorphine/naloxone, they will go into immediate opioid withdrawal.
Brand names for the different formulations of the medication include:
- Bunavail: buprenorphine/naloxone buccal film (placed between gums and inside of the cheek)
- Probuphine: buprenorphine implants
- Sublocade: buprenorphine extended-release injection
- Suboxone: buprenorphine/naloxone sublingual films (placed beneath the tongue)
- Subutex: buprenorphine sublingual tablets
- Zubsolv: buprenorphine/naloxone sublingual tablets
Some formulations may be better for you based on factors like your substance use history and your medication consistency, so your treatment provider can determine the best option for you.
How Does Buprenorphine Work?
Buprenorphine is a partial opioid agonist, which means it binds to opioid receptors in the brain but to a much lesser degree than full opioid agonists, such as methadone, another common opioid addiction medication.
Because buprenorphine is a partial opioid agonist, it helps to:
- Alleviate opioid withdrawal symptoms
- Ease opioid cravings
- Increase safety in case of overdose
- Reduce the risk of misuse
Unlike potent opioids like heroin and prescription painkillers, buprenorphine doesn’t produce a euphoric high.
Is Buprenorphine Safe and Effective?
When taken as prescribed by a doctor or treatment professional, buprenorphine is a safe and effective opioid addiction treatment medication. However, there are some potential risks and precautions patients should be aware of before beginning buprenorphine treatment.
There is a risk of surgical complications with the Probuphine implants. There are also risks of misuse and accidental overdose if a Probuphine implant comes out or protrudes from the skin. In addition, the safety and efficacy of these implants have not been established for people younger than 16 years of age or older than 65 years of age.
However, generally, buprenorphine has a “ceiling effect,” which means that once you reach a certain dose, the opioid effects like respiratory depression level off and don’t increase. This reduces the risk of overdose, misuse, and severe side effects.
Conversely, methadone does not have a ceiling effect and, therefore, has a higher risk of misuse and overdose. Though the effects of buprenorphine are not as strong as those of methadone, they last longer, which means you might be able to take the medication less often than you would take methadone.
Side Effects
Take buprenorphine only as prescribed by your doctor. Any changes to medication frequency or dosage should only happen with direction from your doctor.
Some possible side effects of the medication, which usually go away with time, include:
- Body aches, headaches, and cold-like or flu-like symptoms
- Dizziness
- Constipation
- Sweating
- Tiredness and sleep problems
- Upset stomach
- Vomiting
- Mood swings
Make sure you tell your doctor if these side effects do not go away.
Also, notify your physician immediately if you experience these rare, more severe side effects:
- Dark or tea-colored urine
- Severe stomachache
- Light-colored bowel movements
- Yellowing in the whites of the eyes
- Yellow skin
Is It Possible to Misuse Buprenorphine?
Given that it’s an opioid medication, buprenorphine does have some potential for diversion, misuse, and addiction. There is also a likelihood of misuse of Probuphine if an implant comes out or protrudes from the skin.
However, the overall misuse potential of buprenorphine is lower than that of methadone because the opioid effects are not as strong, and the ceiling effect prevents individuals from taking higher doses to experience a relaxing or euphoric high.
Buprenorphine is a Schedule III Controlled Substance, which means it has a moderate to low risk of dependence and misuse, whereas methadone is classified as a Schedule II drug, which has a higher risk.
Also, due to the addition of naloxone, Suboxone has a particularly low likelihood of misuse since injecting this medication causes the person to go into immediate opioid withdrawal, which involves unpleasant symptoms.
How Long Do I Have to Take Buprenorphine?
How long you would be on buprenorphine depends on your situation; for some, buprenorphine treatment can be for a predetermined period of time before slowly tapering you off of it, and for others, it can be indefinite.
It is important to work closely with your medical professionals in the treatment of opioid use disorder. They can monitor your progress and taper or otherwise adjust your medication in ways that best benefit you.
What Do MAT Programs Involve?
Medication-assisted treatment programs approach addiction treatment from a comprehensive perspective. This means they provide a combination of FDA-approved medications, such as buprenorphine, and counseling as well as other behavioral therapies.
Buprenorphine addresses the physical dependence of an opioid addiction while cognitive and behavioral therapies address the use of healthy coping skills, trigger management, and emotional and interpersonal factors that contribute to addiction. Therapies often include individual and group counseling, and some include family counseling as well.
Research has found that opioid treatment programs (OTPs) with both medication and behavioral treatment are more effective in treating OUD than short-term detox programs aimed at abstinence.
OTPs are governed by federal regulations. They are required to provide counseling and behavioral therapies along with FDA-approved medications and education on the prevention of HIV and other infectious diseases.
Frequently Asked Questions About Buprenorphine and OTPs
Do I Need a Prescription for Naloxone?
No, naloxone or Narcan is now available over the counter for anyone to buy. There is a prescription form of naloxone as well, though, which may be covered by your health insurance.
Talk to your healthcare provider if you prefer the prescription, or you can buy the OTC naloxone at most drug stores. Some OTPs also distribute naloxone for free.
Can I Start Buprenorphine Via Telehealth?
Yes. Because of federal law updates in 2024, it’s now possible for you to start MAT with buprenorphine through a telehealth appointment.
However, every MAT clinic has different processes and requirements, so some clinics or providers might require you to have your first visit in person.
Will I Feel Withdrawal While on Buprenorphine?
Each person’s experience with buprenorphine can vary. Some people will have withdrawal symptoms when they start taking buprenorphine, but the medication can also allow you to have fewer withdrawal symptoms than you’d have if you were to quit opioids without using buprenorphine.
How Long Will I Stay on Buprenorphine?
The timeline for buprenorphine use varies considerably. Some people may only use the medication for a few weeks while they’re at their highest risk for relapse.
Other clients will use it for months or even years. It depends on your specific needs throughout your opioid addiction recovery.
How Can I Find a Buprenorphine Treatment Program or Provider?
You can search for OTPs in your state using the Addictions.com program directory.
Outside of OTPs, not all medical providers are approved to prescribe buprenorphine. However, the limitations on buprenorphine have recently become lighter, so there’s more access to this treatment.
Previously, providers were federally required to apply for and receive a specialized waiver called a DATA-Waiver in order to prescribe buprenorphine, but that requirement was removed in 2023.
Now, any prescriber who is registered with the DEA and has Schedule III authority can prescribe the medication, according to federal law. The DEA now also requires all registrants to complete a one-time training on treating opioid use disorder, known as the MATE Act.
In addition to this, SAMHSA released updated guidance through their 42 CFR Part 8 Final Rule in 2024, which eases some restrictions for MAT in an effort to make this treatment more accessible.
For example, they made telehealth available for MAT, reduced some restrictions on the requirements that candidates have to meet, and improved the availability of take-home doses for some MAT medications.
Keep in mind, however, that state laws still vary regarding buprenorphine, so some states have more requirements and training than others. To find a practitioner near you who prescribes buprenorphine, you can use our locator.
For help finding an opioid addiction treatment program, call the helpline at
800-681-1058
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, or access the Addictions.com directory to find treatment near you.
